SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Drug use is a health issue - fight against the war on drugs and lobby for healthy drug policies (May 2011)

I was excited to attend the 21st IHRA Conference in Beirut and suspected I would return to the UK after it, again celebrating how lucky we are here. Being one of the only GPs who attend this conference I often get asked about ailments by some delegates. Anashka, a Russian delegate, told me her story which particularly humbled me. It related to a rash, which in itself was easy to deal with. More importantly it signified she was HIV positive. I found some cream to treat it and then sat with her to talk to her about living as a HIV positive woman who uses drugs in Russia.

Anashka told me that the HIV rate in people who inject is just under 40% and the HCV rate is even higher. There are 1.8 million (1.78% of the population) people who use drugs in Russia, only 7% of whom have access to needle and syringe programmes (NSP). There is no opioid substitution therapy (OST). HIV, HCV and TB are common causes of death, but the leading cause of death amongst people who use drugs is overdose (Ref 1).

Russia has defended its ban on OST in its 2009 anti-drug policy. Anashka explained that they thought OST was a "failed Western experiment". There is no insight into the link between their appalling drug policy and one of the worst HIV rates in people who inject drugs of which only 0.2% have access to antiretroviral therapy!

She told me that she had previously presented for help many times. Each time she had been assessed as "mad and bad" by psychiatrists and had been put on an enforced quick detox. At first Anashka had thought it was her that was failing then she realised it was the system. This led her to find her own treatment and undertake her own journey.

This complete gap between evidence-based practice and drug policy in Russia (and so many other countries), is why we set up International Doctors for Healthy Drug Policies (IDHDP, two years ago. IDHDP is a network the purpose of which is to increase the participation of medical doctors in drug policy reform and aims to lobby internationally to influence changes to create healthy drug policies. We believe that doctors are in a strong position to help to achieve this.

Attending an international conference and meeting Anashka, who is so representative of so many others in the world, has reinforced several things to me: not just that we are indeed lucky to be here but how both different people and countries are at different stages and can never be treated the same; how treatment is a spectrum and spans provision of NSP to being drug-free with no artificial divide between harm reduction and abstinence. However, there is no room for complacency: even if we have a good system we must never neglect it or stand still. We can always improve it.

- Dr Chris Ford
GP Lonsdale Medical Centre, and Clinical Lead for SMMGP and IDHDP

References & Notes

1. Global State of Harm Reduction 2010 key issues for broadening the response, IHRA

2. Sign up at "HIV & Injecting drug use: a global call for action" - the official declaration of the 2011 IHRC

3. Also sign the Vienna Declaration that argues that prohibitive drug policies do not limit access to currently illicit drugs; they fail to address drug related harms, including increasing rates of HIV amongst injecting drug users, for which there are effective evidence based interventions such as needle and syringe programmes and substitution therapy.